Test Your Billing Definitions and Terms Knowledge

Multiple Choice

1. What is the difference between co-pay and coinsurance?

a. They mean the same thing and used by insurance companies interchangebly

b. Coinsurance is a percentage and copay is a set amount

c. Copay is a percentage and coinsurance is a set amount

d. Coinsurance is the term used only for Medicare patients

2. What does EDI stand for?

a. Employer Designated Insurer

b. External Data Integrity

c. Error on Data Insurance

d. Electronic Data Interchange

3. What is capitation?

a. Pre-established payments to providers for enrollees over a period of time, whether the patient is seen or not by the provider

b. Payment for services rendered by providers and based many times on Medicare fee schedules

c. Services that all inclusive for a procedure, typically 10, 30 or 90 days

d. Health insurance plans that include preventive services

4. What is the definition of "deductible"?

a. The amount the insurance company will pay before patient co-insurance benefits are calculated

b. A specific dollar amount set by the insurance company for each visit or medical service that is rendered

c. The amount the patient is financially responsible before an insurance policy provides payment

d. The amount the insurance company is financially responsible before before other benefits are paid

5. What is the name of the standard claim form used to submit physician office services to Medicare and other insurance payors?

a. UB04

b. CMS1250

c. CMS1500

d. HSA


What is RBRVS?

a. Program with the federal govenemnt to help pay Medicare premiums, deductibles and coinsurance and coinsurance for low monthly
          individuals who have Medicare Part A

b. A fixed fee to physicians for participating and contracting with an insurance payor for services provided to their subscribers

c. A managed care fee-for-service plan that includes prescription drugs

d. Payment system for reimbursement of physician practice expenses base on the physician work, practice expense and malpractice
          insurance expense


Dedicated to making positive changes in your life and career.